Thermal control devices for electrosurgical instruments

ABSTRACT

An effector includes a tubular body having a proximal end and a distal end. The effector holds a plug or closure at the distal end of the tubular body; an active electrode at the distal end of the body; an insulator on the body; and one or more return electrodes on the insulator. The body dissipates heat generated by the one or more return electrodes from the distal end of the body to the proximal end of the body

FIELD

These teachings relate generally to medical instruments, and moreparticularly to devices for controlling heat in electrosurgicalinstruments.

BACKGROUND

Some electrosurgical instruments include an effector having one or moreactive electrodes and one or more return electrodes. The electrodes maybe configured to apply energy to an object or anatomical feature totreat and/or otherwise effect the object or anatomical feature. Forexample, the applied energy can be used to cut, coagulate, seal, weld,dissect, and/or fuilguratc an object or anatomical feature such as avessel, tissue, artery, vein, organ, skin, the like, or a combinationthereof. During use, the one or more return electrodes may become hotterand hotter, which may cause the object or anatomical feature to burn orstick to the effector or to the one or more electrodes. Such burning orsticking may increase the amount of time required to preform the medicalprocedure, may increase bleeding and/or tissue damage, or a combinationthereof. Moreover, the increased temperature or heat at the returnelectrodes may cause the return electrodes to become the activeelectrodes, supplying a diffused or unintended effect. Equally, thisadditional heating may also cause arcing between electrodes due toincreased energy in the area, particularly with bipolar cutting devices,potentially leading to a coagulating effect.

Some attempts have been made to thermally control and/or cool the returnelectrodes. For example, the size of the return electrodes have beenincreased to help dissipate heat from the return electrodes; however,incorporating larger electrodes undesirably increases the section sizeand weight of the effector or medical instrument, which is less thanideal for laparoscopic or minimally invasive procedures. Other attemptsinclude incorporating individual fluid cooling, heat pipes, and/or heattubes for each individual return electrode. However, incorporatingindividual fluid cooling, heat pipes, and/or heat tubes for each returnelectrode may also undesirably increase the size, weight, and/or cost ofthe effector or medical instrument. Some electrosurgical instruments aredisclosed in U.S. Patent Application Publication Numbers: 2003/0125732,2006/0264929, 2014/0276804, 2014/0276786, 2014/0276799, 20140276800,2014/0276772, 2014; 0276795, 2014/0276797, 2014/0276795, 20140276796,2014/0276797, 2014/0276798, 2014/0276794, 2014/0276785, and201510282873, and in U.S. Pat. Nos. 6,942,662, 6,832,998, 4674498,4850353, 4862890, and 4958539—the disclosures of which, including allcorresponding priority documents for these disclosures, are allincorporated by reference herein for all purposes.

It may be desirable to improve the current state of the art by providinga device for thermally controlling an electrosurgical instrument. Thatis, it may be desirable to cool the one or more return electrodes and/orthe effector without increasing a section size or weight of theelectrosurgical instrument and/or the effector and without increasingthe cost and/or the complexity thereof.

SUMMARY

An effector is provided that includes a tubular body having a proximalend and a distal end. The effector includes a plug at the distal end ofthe tubular body; an active electrode provided at the distal end of thebody; an insulator on the body; and one or more return electrodes on theinsulator. The body dissipates heat generated by the one or more returnelectrodes from the distal end of the body to the proximal end of thebody.

An effector is provided that includes a body, a plug, an activeelectrode, an insulator on the body, and one or more return electrodes.The body has an interior portion, a proximal end, and a distal end. Theplug is located at the distal end of the body. The active electrode incommunication with the plug. The one or more return electrodes locatedon the insulator. The body dissipates heat from the distal end of thebody to the proximal end of the body. The one or more return electrodesare vapor deposited onto the insulator.

A method of making an effector is also provided. The method includessteps of: providing an insulator over at least a portion of a tubularbody having a proximal end and a distal end; providing a plug at thedistal end of the body; and providing an active electrode incommunication with the plug and extending from the distal end of thebody. The method also includes steps of insulating at least a portion ofthe body with an insulator; and providing one or more electrodes on theinsulator.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of an effector.

FIG. 1B is a perspective view of an effector.

FIG. 2 is a cross-sectional view of an effector.

FIG. 3 is a perspective view of an instrument including an effector.

DETAILED DESCRIPTION

The explanations and illustrations presented herein are intended toacquaint others skilled in the art with the teachings, its principles,and its practical application. Those skilled in the art may adapt andapply the teachings in its numerous forms, as may be best suited to therequirements of a particular use. Accordingly, the specific embodimentsof the present teachings as set forth are not intended as beingexhaustive or limiting of the teachings. The scope of the teachingsshould, therefore, be determined not with reference to the abovedescription, but should instead be determined with reference to theappended claims, along with the full scope of equivalents to which suchclaims are entitled. The disclosures of all articles and references,including patent applications and publications, are incorporated byreference for all purposes. Other combinations are also possible as willbe gleaned from the following claims, which are also hereby incorporatedby reference into this written description.

The present disclosure provides one or more effectors. The one or moreeffectors may be any device, instrument, or component thereof that isadapted to effect or treat an object or anatomical feature of interest.For example, the effector can be used to move, grip, grasp, capture,compress, push, pull, cut, coagulate, weld, seal, dissect futlgurate,perform hemostasis, and/or otherwise effect an object or anatomicalfeature such as a vessel, tissue, artery, vein, organ, skin, the like,or a combination thereof. The one or more effectors can be used invirtually any medical procedure. For example, the effector can be usedin open procedures, laparoscopic procedures, minimally invasiveprocedures, electrosurgical procedures, or a combination thereof.

One or more instruments can comprise one or more of the effectors. Theone or more instruments can be used in medical procedures, innon-medical procedures, or both. Exemplary instruments include forceps,tweezers, a dissector, scissors, a scalpel, a spatula, a hook, J-hook,or a combination thereof. The effector can be included in a combodevice. For example, the effector can be a central component locatedbetween opposing arms, and can function as a monopolar blade electrode,a bipolar blade electrode, or both. In such a configuration, the arms ofthe combo device need not include electrodes, thus resulting in aless-expensive and less-complicated construction. That is, the arms ofthe combo device can function as gripping or grasping arms. The one ormore instruments, effectors, or both may be fully and/or partiallydisposable, reusable, reposable, or a combination thereof.

The instrument may be a forceps. The forceps may include at least twoarms, a blade electrode, or a combination of both. The arms may be anypart that may be used to grip, hold, squeeze, surgically effect, or acombination thereof an object or anatomical feature. The arms mayinclude one or more gripping features that may assist in gripping,holding, squeezing, or a combination thereof an object or anatomicalfeature. One or both of the arms may be movable. One or both of the armsmay be longitudinally static and moveable relative to each other.Preferably, at least one of the arms is both longitudinally movable(e.g., movable along the length of the hand piece) and laterally movable(e.g., movable towards and away from an opposing arm). The arms may beselectively retractable and/or extendable so that one or more tipregions are exposed. The arms, the blade electrode, or a combinationthereof may be or may include one or more of the effectors disclosedherein. The arms, the blade electrode, or a combination thereof mayinclude the effector, the one or more electrodes, or both. The effector,the arms, the blade electrode, or a combination thereof may include atip region. The tip region may include a portion that is configured toassist in facilitating gripping, holding, squeezing, transferring of atherapy current, or a combination thereof. The tip region may be locatedat a distal end of the effector, arms, blade electrode, or a combinationthereof. The tip region may include teeth, serrations, mouse teeth, befree of teeth (i.e., smooth), or a combination thereof. The tip regionmay include the effector, the one or more electrodes, or a combinationthereof.

The one or more effectors, instruments, or both can be used with orwithout power. When used with power, the one or more effectors,instruments, electrodes, or a combination thereof can supply one or moreelectrical currents, therapies, and/or signals. When used with power,the one or more effectors, instruments, electrodes, or a combinationthereof can supply electrical energy, ultrasonic energy, heat energy, RFenergy, or a combination thereof to treat or effect an object oranatomical feature. The one or more effectors or instruments can be usedwith monopolar energy, bipolar energy, a blended energy comprisingmonopolar and bipolar energy, or a combination thereof. During use, theenergy, current, therapy, and/or signal may be passed from, through, orbetween the effector, the one or more electrodes, a remote pad, apatient or anatomy, or a combination thereof to electrically effect anobject or anatomical feature. Electrically effect an object oranatomical feature may include cutting, dissecting, coagulating,welding, sealing, fulgurating, performing hemostasis, etc.

The one or more effectors, instruments, or both can be used in amonopolar mode, a bipolar mode, or both. The one or more effectors,instruments, or both can be switched between the monopolar mode and thebipolar mode by closing one or more activation circuits. Switchingbetween the monopolar mode and the bipolar mode may be done bymanipulating one or more user inputs on the hand piece of theinstrument, at a remote location (e.g., a foot pad), or a combinationthereof. Switching between the monopolar mode and the bipolar mode maybe done at a surgical site without having to remove the instrument fromthe surgical site or swap the instrument with another instrument.

In the monopolar mode, one or more electrical energies, currents,therapies, and/or signals may be passed from one pole or electrode(s) ofthe instrument, effector, or both, to or through an object or anatomicalfeature, to another pole or electrode(s) located at a remote locationsuch as a remote pad or patient pad. The electrical energy, current,therapy and/or signal can be passed to or through the object or anatomyto cut, dissect, coagulate, fulgurate, weld, seal, perform hemostasis,etc. on the object or anatomy.

In the bipolar mode, one or more suitable electrical energies, currents,therapies, and/or signals may be passed from a pole or electrode(s)located on the effector, instrument, or both to or through an object oranatomical feature, to another pole or electrode(s) located on theeffector, instrument, or both. The electrical energy, current, therapyand/or signal can be passed to or through the object or anatomy to cut,dissect, coagulate, fulgurate, weld, seal, perform hemostasis, etc. onthe object or anatomy.

In the bipolar mode, the instrument, effector, or both can be selectedor switched to operate in a first bipolar electrical mode, a secondbipolar electrical mode, and a third bipolar electrical mode.

In the first bipolar electrical mode, one or more electrical energies,currents, therapies, and/or signals can be passed to or through anobject or anatomical feature from one or more active electrodes to oneor more return electrodes.

In the second bipolar electrical mode, the one or more active electrodesmay be dormant and one or more electrical energies, currents, therapies,and/or signals can be passed to or through an object or anatomicalfeature between the one or more return electrodes.

In the third bipolar electrical mode, the instrument, effector, or bothcan be modulated or switched between the first bipolar electrical modeand the second bipolar electrical mode. That is, for a selected periodof time, the electrical energies, currents, therapies, and/or signalsare passed to or through an object or anatomical feature from one ormore active electrodes to one or more return electrodes. Then foranother period of time, the electrical energies, currents, therapies,and/or signals are passed to or through an object or anatomical featurebetween the one or more return electrodes. In the third bipolarelectrical mode, a user may be able to select the amount of time each ofthe modes operate or could be automatically controlled by the powersource logic based on feedback. In the third bipolar electrical mode,the modulation or switching can be automatically controlled, manuallycontrolled, or both.

The one or more electrical energies, currents, therapies, and/or signalscan be supplied to the one or more electrodes, effectors, instruments,or a combination thereof by one or more suitable sources. An example ofa suitable source is a generator. The source or generator may supplyelectrical energy, ultrasonic energy, heat energy, RF energy, or acombination thereof. The source or generator may include one or morepower connections. The power connections may be any port or connectionon the source or generator that one or more power connectors, leads, orwire from the instrument or effector may be plugged into so that the oneor more electrical energies, currents, therapies, and/or signals can besupplied to the electrodes, instrument, effector, or a combinationthereof. The source or generator may include a central processing unit(CPU). The source, generator, CPU, or a combination thereof may be usedto switch the electrodes, effector, the instrument, or a combinationthereof to operate in the monopolar mode, the bipolar mode, the firstbipolar electrical mode, the bipolar second electrical mode, the thirdbipolar electrical mode, or any combination thereof.

The one or more effectors can include one or more bodies. The body mayfunction to provide structure for the effector. The body may function todissipate heat or transfer heat from a region having a greaterconcentration of heat to a region having a lower concentration of heat.For example, the body may dissipate heat or transfer heat from a distalend of the effector or body to a proximal end of the effector or body: acentral portion of the effector or body to a proximal end of theeffector or body; or a combination thereof. For example, the body maydissipate heat or transfer heat from the one or more return electrodesso that the return electrodes do not overheat or get too hot. Forexample, the body may dissipate heat or transfer heat from the one ormore active electrodes so that the active electrodes do not overheat orget too hot. The body may be electrically connected to the generator andmay function to electrically power the one or more active electrodes.

The body may be a member extending between a proximal end and a distalend. The body may be an elongated member. The body may be substantiallystraight, or may include one or more bends, turns, and/or arcs. The bodymay be substantially rigid. The body may include one or more portionsthat are substantially flexible and/or resilient. The body may betubular, hollow, solid, or may include portions that are hollow andsolid. The body may include a generally constant, uniform cross section,or the cross section may change or vary along a length thereof. The bodycan have one or more open ends. One or both of the open ends of the bodycan be closed by either squeezing or crimping the ends; sealing the endswith solder or welding; plugging the ends with one or more plugs orclosures; or a combination thereof. The plug can be a closed ended tubethat is closed by squeezing, crimping, sealing with solder or welding,or a combination thereof. The body may have a wall thickness on theorder of approximately 0.20 mm or more, 0.30 mm or more, 0.40 mm ormore, 0.50 mm or more, 0.60 mm or more, 0.70 mm or more, 0.75 mm ormore, or even 0.80 mm or more. The body may have a wall thickness on theorder of approximately 1.00 mm or less, 0.90 mm or less, 0.80 mm orless. Preferably, the body has a thickness on the order of approximately0.75 mm.

The body may be made from any suitable material. Preferably, the body ismade from a material suitable for use in medical procedures. Preferably,the body is made from a material with good thermal conductionproperties, thermal dissipation properties, or both. For example, thebody may comprise a heat pipe, a heat tube, copper, silver, aluminum,gold, graphene formed into rods, graphene formed into ropes, steel,carbon, a material with high thermal dissipation, or a combinationthereof.

The body may comprise one or more heat pipes, one or more heat tubes,one or more central heat dissipators, or a combination thereof. The oneor more heat pipes, heat tubes, or central heat dissipators may functionto dissipate or transfer heat from a region having a greaterconcentration of heat to a region having a lower concentration of heat.For example, the one or more heat pipes, heat tubes, or central heatdissipators may dissipate or transfer heat from a distal end of theeffector or body to a proximal end of the effector or body; a centralportion of the effector or body to a proximal end of the effector orbody; or a combination thereof. For example, the one or more heat pipes,heat tubes, or central heat dissipators may dissipate heat or transferheat from the one or more return electrodes so that the returnelectrodes do not overheat or get too hot. It may be desirable totransfer heat from the one or more return electrodes so that an objector anatomical feature does not stick or burn to the return electrodes;so that the return electrodes do not become the active electrodes, or acombination thereof. It is contemplated that during use, preferably, theactive electrode will be hotter than the return electrodes. It iscontemplated that it is preferable for the active electrode to get hot,particularly at the distal tip.

A heat pipe may be defined as a heat transfer unit, a solid statedissipator, piece of material that can transfer heat readily, and/or maybe a vacuum containing fluid that moves to create a cooling effect. Thecentral heat dissipator, heat tube, or both may be sealed, may beself-contained, and may include a vacuum, or a combination thereof sothat additional fluid is not needed to perform a cooling function,similar to a heat pipe. The heat pipe may include a suitable fluid toabsorb heat, remove heat, dissipate heat, or a combination thereof. Forexample, the heat pipe may be filled with water, alcohol, sodium,ammonia, ethanol, methanol, or a combination thereof. The fluid mayundergo one or more phase changes, and preferably two or more phasechanges (e.g., evaporation, condensation, or both) that assist inremoving heat from the one or more electrodes, the body, the effector,or a combination thereof.

The one or more heat pipes may be sufficiently long and/or have asufficiently large cross-sectional thickness (e.g., diameter) so thatfluid may travel from the distal end of the heat pipe to the proximalend of the heat pipe so that the fluid is cooled. The one or more heatpipes may be sufficiently long and/or have a sufficient cross-sectionalthickness so that evaporated fluid can travel from the hot end of theheat pipe (e.g., distal end) to the cool end of the heat pipe (e.g.,proximal end) where the fluid condenses. During use, when the electrodesat the distal end of the body or heat pipe are heated, the fluid withinthe body or heat pipe may be heated. The heated fluid may thenevaporate. The evaporated fluid may move from the distal end of the heatpipe or body to the proximal end where the heated fluid may condense andrelease the heat. The condensate may then move from the proximal endback to the distal end and the cycle repeats. The fluid, when condensed,may travel from the cool end to the hot end via capillary action,gravity, or a combination thereof. The ends of the one or more bodies orheat pipes may be closed by either squeezing and sealing it with solderor plugging the ends with one or more plugs.

The one or more effectors, bodies, or both may include one or more plugsor closures. The one or more plugs or closures may be a closing that mayor may not be hermetically sealed. The one or more plugs or closures maybe a crimped section which may include solder. The one or more plugs mayfunction to seal or cap one or more ends of the body, the heat pipe, orboth. The one or more plugs may function to be used to affect an objector anatomical feature. The one or more plugs may also incorporate steel,copper, silver, aluminum, graphene, gold, carbon, or another materialthat is known to improve cut performance of the device tip, or acombination thereof. The one or more plugs may be equipped with acoating shim that minimizes heat transfer into the plug. The one or moreplugs may be formed from a suitable material that has poor thermalconduction so that heat from the cut element of the plug, the activeelectrode, or both is not transferred, dissipated, or lost via thethermally conductive heat pipe, body, or both. The one or more plugs maybe formed from a suitable material that has poor thermal conduction sothat heat from the plug, the active electrode, or both is nottransferred to the insulator, the body, the heat pipe, or a combinationthereof. The one or more plugs may be formed from a suitable materialthat has poor thermal conduction so that the one or more activeelectrodes in communication with the plug get hot first and function asthe active electrode and maintain the heat. The one or more plugs may beat least partially inserted into an inner portion of the body, heatpipe, or both. The one or more plugs may be press-fit into the distalopening of the body, the heat pipe, or both, and/or may be securedthereto with a suitable mechanical fastener, an adhesive, welding,soldering, or a combination thereof. The one or more plugs may receiveat least a portion of a blade, an active electrode, or both. The one ormore blades, active electrodes, or both may be embedded in the plug. Theone or more plugs may be an active electrode. The one or more plugs orclosures may contain, receive, or be one or more return electrodes. Theone or more plugs may be in communication with a source of energy suchas a generator. At least a portion of the plug, a portion of the blade,or both can be coated with the insulator so that the active electrode,the plug, or both are separated from the return electrodes.

The one or more effectors, bodies, or both may include one or moreinsulators. The insulator may coat at least a portion of the effector,body, plug, or a combination thereof. For example, the distal end of theeffector, the plug, or both may include the insulator. The insulator mayfunction to electrically separate the active electrodes and the plugsfrom the return electrodes. The insulator may function as a thermalconductor so that heat from the one or more return electrodes can betransferred or dissipated to the body, heat pipe, or both.

The one or more insulators may comprise any suitable material.Preferably, the insulator comprises a material having good dielectricstrength, are resistance, or both. For example, the insulator maycomprise a material that has a dielectric strength on the order ofapproximately 1 ac-kV/mm or more, 5 ac-kV/mm or more, 10 ac-kV/mm ormore, 15 ac-kV/mm or more, 20 ac-kV/mm or more, 50 ac-kV/mm or more, 75ac-kV/mm or more, 90 ac-kV/mm or more or even 95 ac-kV/mm or more. Theinsulator may comprise a material that has a dielectric strength on theorder of approximately 200 ac-kV/mm or less ac, 100 ac-kV/mm or less, 97ac-kV/mm or less, 50 ac-kV/mm or less, 25 ac-kV/mm or less, 20 ac-kV/mmor less, 18 a-kV/mm or less, 16 ac-kV/mm or less, 15 ac-kV/in or less,10 ac-kV/mm or less, 8 ac-kV/mm or less, 7 ac-kV/mm or less. Theinsulator may include a material having good thermal transferproperties. For example, the insulator may comprise a material that hasa thermal conductivity of 1 W/mºK or more, 2 W/mºK or more, 5 W/mºK ormore, 15 W/mºK or more, 20 W/mºK or more, 30 W/mºK or more, 50 W/mºK ormore, 75 W/mºK or more, 100 W/mºK or more, 125 W/mºK or more, or even130 W/mºK or more. The thermal conductively of the insulator may be onthe order of 200 W/mºK or less, 175 W/mºK or less, 150 W/mºK or less,140 W/mºK, 100 W/mºK or less, 60 W/mºK or less, 50 W/mºK or less, 35W/mºK or less, 32 W/mºK or less, 5 W/mºK or less, or 3 W/mºK or less.

The insulator may be thin enough to optimize the thermal conduction, butthick enough to provide electrical insulation from the one or moreelectrodes. For example, the insulator may have a thickness on the orderof approximately 0.001 mm or more, 0.01 mm or more, 0.02 mm or more,0.03 mm or more, 0.04 mm or more, 0.05 mm or more, 0.06 mm or more, 0.07mm or more, 0.08 mm or more, 0.09 mm or more, 0.10 mm or more, 0.15 mmor more, 0.16 mm or more, or even 0.20 mm or more.

If a ceramic is used for the insulator, an Alumina based material may bepreferred over a Silicon Nitride version because Alumina may have betterthermal conductivity than Silicon Nitrade. Exemplary insulators mayinclude silicone or polytetrafluoroethylene (PTFE), Aluminum Nitride.Aluminum Oxide, Silicon Nitride, Zirconium Oxide MgO stabilized. BoronNitride, Yttria stabilized Zirconia, diamond like carbon (DLC), or acombination thereof.

The one or more insulators can be applied to the body or heat pipe viaany suitable methods. For example, the insulator can be a coating orspray on the body or heat pipe. Preferably, the one or more insulatorsare applied to the body, heat pipe, or both such that little or no gaps(e.g., air gaps) are between the insulator and the body or the heatpipe. An air gap may function as a thermal barrier between the insulatorand the heat pipe or body and prevent heat from the return electrodesfrom being properly and efficiently transferred or dissipated via thebody, the heat pipe, or both.

The one or more electors, bodies, or both may include one or moreelectrodes. The electrodes may function to pass, transfer, and/orreceive one or more electrical energies, currents, therapies, and/orsignals. The one or more electrodes may function to pass one or moreelectrical currents, therapies, and/or signals to or through one or moreobjects, anatomical features, or both. The one or more electrodes mayinclude materials that are good electrical conductors. For example, theone or more electrodes may comprise steel, copper, iron, nickel,tungsten, steel, stainless steel, surgical steel, copper, titaniumnitride, or a combination thereof. The one or more electrodes may becoated with a material that conducts electricity.

The one or more electrodes may be electrically connected to one or moregenerators or other sources of energy. The one or more electrodes may beelectrically connected to one or more generators or sources of energyvia any suitable manner. For example, one or more wires, traces, orconductors can connect the electrodes to lead wires from the generator.The body may function to electrically connect the one or more activeelectrodes to the generator.

The one or more electrodes may comprise one or more active electrodesand one or more return electrodes. The one or more active electrodes mayfunction to pass, transfer, and/or deliver the one or more electricalenergies, currents, therapies, and/or signals to the object, anatomicalfeature, the one or more return electrodes, or a combination thereof.Preferably, the one or more active electrodes comprise a material thatretains heat, has a low thermal conductivity, or both. The one or moreactive electrodes may be positioned at a distal end or tip of theeffector, body, heat pipe, heat tube, central heat dissipater, orcombination thereof. For example, in some configurations, it may bepreferred for the active electrode or blade be positioned as far awayfrom the body or heat pipe as possible. This may be desirable inmonopolar uses where voltages are much larger, which tends to heat theactive electrode more. Accordingly, in monopolar uses, it may bedesirable to prevent the heat from the active electrode fromtransferring or conducting to the body or heat pipe so that the returnelectrodes are not heated and/or so that the body or heat pipe can bereserved for cooling only the return electrodes. The one or more activeelectrodes may be in communication or extend from one or more plugs inthe body, heat pipe or both. The one or more active electrodes may haveany shape. The active electrode may include a blade. The effector mayinclude any sire and any number of active electrodes. Preferably, thesize and number of active electrodes is less than the size and number ofreturn electrodes.

The one or more return electrodes may function to provide a return pathfor the one or more electrical currents, therapies, and/or signals.Preferably, the one or more return electrodes are spaced apart from theone or more active electrodes. The one or more return electrodes may beprovided on the insulator. The one or more electrodes may be attached toor formed on the body in any suitable way. For example, the one or morereturn electrodes may be printed, screen printed, ink-jet printed,etched, soldered, stamped, sprayed, formed in metallized tracks, orvapor deposited onto the body, the insulator, or both. Preferably, theone or more return electrodes are deposited onto the body, theinsulator, or both such that little or no gaps (e.g., air gaps) arelocated between the return electrodes and the body, the insulator, orboth. An air gap may function as a thermal barrier between the returnelectrode and the insulator, body, or both and prevent heat from thereturn electrodes from being properly and efficiently transferred ordissipated via the body, the heat pipe, or both.

The effector may include any size and any number of return electrodes.Preferably, the size and number of return electrodes is more than thesize and number of active electrodes. For example, the effector mayinclude two or more return electrodes, three or more return electrodes,four or more return electrodes. In some configurations, the effector mayinclude two return electrodes—one return electrode on each side orsurface of the effector or tip. In other configurations, the effectormay include four return electrodes—two return electrodes on each side orsurface of the effector or tip.

The effector may comprise one or more blades. The one or more blades maybe made of steel or other material that has poor thermal conduction sothat the one or more blades get hotter faster and acts as the one ormore active electrodes. The one or more blades may have any suitableshape so that the elector or medical instrument can be used as aspatula, hook, a knife, or a combination thereof. The one or more bladesmay be moveable relative to a distal end of the body, heat pipe or bothso that the blade can be positioned away from the body in someconfigurations and close to the body in other configurations. Forexample, in some configurations, it may be preferred for the blade to bepositioned further from the body or heat pipe so that heat from theblade can be prevented from transferring or conducting to the body orheat pipe. Accordingly, moving the blade away from the body in someconfigurations may prevent the return electrodes from heating.

The effector may include one or more heat sinks. The one or more heatsinks may be connected to the one or more bodies, heat pipes, or both.Each body, heat pipe, or both may be connected to a heat sink, have anintegral beat sink, or both. The bodies, heat pipes, or both may extendthrough the heat sinks and the heat sinks may remove heat therefromthrough thermal contact. The body, heat pipe, or both may transfer heatto the heat sink via a heat transfer medium (e.g., a thermal paste) sothat heat is transferred from the body, heat pipe, or both to the heatsink. The heat sink and the heat pipes may be made of the same material.The heat sink may be an extended portion of the body, heat pipe, or boththat acts to dissipate heat. For example a coil or other extended shapemay extend from an end of the body, heat pipe, or both and may allow forheat transfer. The heat sink may be located on the cold end of the body,beat pipe, or both, on the proximal end of the body, heat pipe, or both,or a combination thereof. The heat sink may increase the surface area ofeach of the one or more heat pipes, bodies, or both. The heat sink maybe partially and or entirely shielded from contact by the user so thatheat from the body, heat pipe, the heat sink, or a combination thereofdoes not directly contact the user. The heat sink may be made of amaterial with high conductivity, higher conductivity than the heat pipe,or both. The heat sink may use natural convection, forced convection, orboth to dissipate heat. The heat sink may include one or more heatexchange surfaces that dissipate heat from the fluid. The one or moreheat exchange surfaces may increase the surface area of the heatexchanger relative to the body, heat pipe, or both, so that heat isdissipated. The surface area of the heat exchange surface may be abouttwo times or more, about three times or more, or even about tour timesor more than the surface area of the body, heat pipe, or both. The oneor more heat exchange surfaces may be and/or include tins, baffles, anincrease in surface area, tubes, plates, ribs, or a combination thereof.

The effector may include one or more fluid evacuation conduits. The oneor more fluid evacuation conduits may function to remove smoke and/orair during an electrosurgical procedure. The fluid evacuation conduitsmay function to draw air from a point of interest so that at leastlocalized air movement is created. The fluid evacuation conduit mayfunction to circulate air around an electrosurgical instrument so thatthe instrument is cooled. The fluid evacuation conduits may be anintegral part of the body, the heat pipe, or both. The fluid evacuationconduits may be in communication with the blade electrode. The fluidevacuation conduit may be connected to the body, the heat pipe, or bothso that air is removed from a region proximate to the distal end of theeffector, instrument, or both during performance of a surgicalprocedure. The one or more fluid evacuation conduits may move asufficient amount of air so that a majority (i.e., 50 percent or more,60 percent or more, 75 percent or more, or even 90 percent or more) ofthe smoke is removed from the distal end of the effector, theinstrument, or both as the smoke is created. Each of the one or morefluid evacuation conduits may move about 0.03 m³/min or more, about 0.15m³/min or more, about 0.3 m³/min or more, or even about 0.75 m/min ormore. The fluid evacuation conduits may be on all time theelectrosurgical instrument is connected to a power source, a vacuumsource, or both. The fluid evacuation conduits may turn on only when atherapy current or energy is being applied. The one or more fluidevacuation conduits may be statically located on the effector. The fluidevacuation conduits may be movable on the instrument so that the fluidevacuation conduit may be moved to a location of smoke creation. Thefluid evacuation conduit may be a series of holes in a tip region of thebody heat pipe, or both. The fluid evacuation conduit may be a series ofholes along a length of the heat pipe, body, or both. Preferably, thefluid evacuation conduit is connected to the effector and is movablewith the body when the effector is moved.

FIGS. 1A and 1B illustrate an exemplary effector 10. The effector 10includes a body 12 extending between a proximal end 14 and a distal end16. The effector 10 includes an insulator 18, and a tip portion 20comprising an active electrode 22 and return electrodes 24. The effector10, the one or more of the electrodes 22, 24, or a combination thereofare in communication with a generator 26 via leads 28. Leads can alsoconnect the effector 10, the one or more of the electrodes 22, 24, thegenerator 26, or a combination thereof to a remote pad or patient pad38.

FIG. 2 illustrates a cross section of an exemplary effector 10. In someconfigurations, an interior portion 30 of the body 12 includes a heattransfer fluid 32. The effector 10 includes an insulator 18 and returnelectrodes 24. The effector 10 includes a plug 34 extending from adistal end 16 of the body 12. The active electrode 22 is incommunication with the plug 34. The active electrode 22 may be a blade36.

FIG. 3 illustrates an exemplary instrument 100 that is a forceps. Theinstrument 100 includes a first arm 102, a second arm 104, and a blade106. One or more of the first arm 102, the second arm 104, and the blade106 comprise the effector 10. The blade 106 may be a blade electrode.

The instrument 100 includes a handle 108 with controls 110 formanipulating and switching the instrument 100 to operate in a monopolarmode, a bipolar mode, a first bipolar electrical mode, a bipolar secondelectrical mode, a third bipolar electrical mode, or any combinationthereof.

Any numerical values recited herein include all values from the lowervalue to the upper value in increments of one unit provided that thereis a separation of at least 2 units between any lower value and anyhigher value. As an example, if it is stated that the amount of acomponent or a value of a process variable such as, for example,temperature, pressure, time and the like is, for example, from 1 to 90,preferably from 20 to 80, more preferably from 30 to 70, it is intendedthat values such as 15 to 85, 22 to 68, 43 to 51, 30 to 32 etc, areexpressly enumerated in this specification. For values which are lessthan one, one unit is considered to be 0.0001, 0.001, 0.01 or 0.1 asappropriate. These are only examples of what is specifically intendedand all possible combinations of numerical values between the lowestvalue and the highest value enumerated are to be considered to beexpressly stated in this application in a similar manner. As can beseen, the teaching of amounts expressed as “parts by weight” herein alsocontemplates the same ranges expressed in terms of percent by weight.Thus, an expression in the Detailed Description of the Teachings of arange in terms of at “‘x’ parts by weight of the resulting polymericblend composition” also contemplates a teaching of ranges of samerecited amount of “x” in percent by weight of the resulting polymericblend composition.”

Unless otherwise stated, all ranges include both endpoints and allnumbers between the endpoints. The use of “about” or “approximately” inconnection with a range applies to both ends of the range. Thus, “about20 to 30” is intended to cover “about 20 to about 30”, inclusive of atleast the specified endpoints.

The disclosures of all articles and references, including patentapplications and publications, are incorporated by reference for allpurposes. The term “consisting essentially of” to describe a combinationshall include the elements, ingredients, components or steps identified,and such other elements ingredients, components or steps that do notmaterially affect the basic and novel characteristics of thecombination. The use of the terms “comprising” or “including” todescribe combinations of elements, ingredients, components or stepsherein also contemplates embodiments that consist essentially of theelements, ingredients, components or steps.

Plural elements, ingredients, components or steps can be provided by asingle integrated element, ingredient, component or step. Alternatively,a single integrated element, ingredient, component or step might bedivided into separate plural elements, ingredients, components or steps.The disclosure of “a” or “one” to describe an element, ingredient,component or step is not intended to foreclose additional elements,ingredients, components or steps.

It is understood that the above description is intended to beillustrative and not restrictive. Many embodiments as well as manyapplications besides the examples provided will be apparent to those ofskill in the art upon reading the above description. The scope of theteachings should, therefore, be determined not with reference to theabove description, but should instead be determined with reference tothe appended claims, along with the full scope of equivalents to whichsuch claims are entitled. The disclosures of all articles andreferences, including patent applications and publications, areincorporated by reference for all purposes. The omission in thefollowing claims of any aspect of subject matter that is disclosedherein is not a disclaimer of such subject matter, nor should it beregarded that the inventors did not consider such subject matter to bepart of the disclosed inventive subject matter.

1. (canceled)
 2. An effector comprising: an electrically conductive bodyhaving a proximal end and a distal end; an active electrode at thedistal end of the body; an electrical insulator on the body; and one ormore return electrodes on the insulator; wherein the active electrode iselectrically connected to the body and the one or more return electrodesare electrically insulated from the body.
 3. The effector of claim 2,wherein the body comprises at least one of a copper tube or a heat pipe.4. The effector of claim 2, wherein the one or more return electrodesare printed onto the insulator.
 5. The effector of claim 2, wherein theone or more return electrodes are vapor deposited onto the insulator. 6.The effector of claim 2, wherein the one or more return electrodes aresprayed onto the insulator.
 7. The effector of claim 2, wherein the oneor more return electrodes are etched or stamped into the insulator. 8.The effector of claim 2, wherein the active electrode is a portion of anelectrically conductive plug attached to the distal end of the body. 9.The effector of claim 8, wherein a thermal conductivity of the plug islower than a thermal conductivity of the body.
 10. The effector of claim9, wherein at least a portion of the plug is coated with the insulator.11. The effector of claim 8, wherein the plug is at least partiallyinserted into an inner portion of the body.
 12. The effector of claim 2,wherein the insulator comprises a coating applied to at least a portionof the body.
 13. The effector of claim 2, further comprising a heat sinkcoupled to the body and configured for transferring heat away from thebody.
 14. The effector of claim 2, wherein the active electrode is madeof steel.
 15. The effector of claim 2, wherein the one or more returnelectrodes comprise a plurality of the return electrodes.
 16. Theeffector of claim 15, wherein the body includes a tip portion comprisingan upper surface having one of the return electrodes and a lower surfacehaving another one of the return electrodes.
 17. The effector of claim2, wherein the effector is a component of an electrosurgical instrumentoperable in a bipolar mode, wherein the one or more return electrodescomprise a plurality of the return electrodes, wherein in the bipolarmode, the electrosurgical instrument is switchable between a firstbipolar electrical mode and a second bipolar electrosurgical mode, andwherein in the first bipolar electrical mode a first therapy current isprovided to anatomy from the active electrode to at least one of thereturn electrodes and in the second bipolar electrosurgical mode asecond therapy current is provided to the anatomy between two or more ofthe return electrodes.
 18. An effector comprising: an electricallyconductive body having a proximal end and a distal end; an activeelectrode electrically coupled to the body at the distal end; anelectrical insulator disposed on at least a portion of the body; and oneor more return electrodes disposed on the insulator such that the one ormore return electrodes are electrically insulated from the body; whereinthe insulator is configured to function as a thermal conductor totransfer heat from the one or more return electrodes to the body. 19.The effector of claim 18, wherein the active electrode is a portion ofan electrically conductive plug attached to the distal end of the body.20. A method of making an effector comprising: providing an insulatorover at least a portion of a tubular body having a proximal end and adistal end; providing an active electrode at the distal end of the body;and providing one or more return electrodes on the insulator.
 21. Themethod of claim 20, wherein the active electrode is disposed on aportion of an electrically conductive plug, the method furthercomprising: inserting the plug at least partially into an inner portionof the body.